Progress Against Malaria in Africa Is Real but Fragile

On this past Monday, April 25 — World Malaria Day — the news from Africa was good.

Over the past decade, 11 African countries have seen the number of confirmed malaria cases, malaria-related hospital admissions or deaths drop by more than 50%, according to 2009 data. When 2010 figures become available we expect to see similar progress in even more countries.

The good news stems in part from the fact that approximately three-quarters of the people at risk of contracting malaria in Africa, which bears the disease’s heaviest burden of death and debilitating illness, were using insecticide-treated mosquito nets by the end of 2010. That suggests that the goal of protecting the whole of Africa’s population with bed nets and effectively preventing the fevers and crushing headaches of malaria appears within reach. (See how malaria has crippled one town in Uganda.)

More welcome news: global deaths from malaria have fallen from nearly a million a year in 2000 to 781,000 in 2009. But even while we mark what may be a turning point in our effort to eradicate the disease, we cannot overestimate our progress. It is fragile.

Malaria continues to exact a great toll, killing three-quarters of a million people a year, more than 90% in Africa, which accounts for about one in six child deaths. The consequences of losing our focus now would be deadly. Mosquito bed nets last about three years, and a failure to replace the more than 300 million nets blanketing Africa over the coming three years could lead to resurgent malaria illness and deaths. Just this past year, Zambia faced a resurgence of malaria in a few provinces when mosquito nets were not replaced in time. Deaths and illness increased within months. Rapid action to address this increase has since been taken by the Zambian government, together with the World Bank, U.N. Foundation, Bill and Melinda Gates Foundation, Stanbic Bank, the African Leaders Malaria Alliance (ALMA), and the U.N. Special Envoy’s Office. (See photos of the most malarial town on Earth.)

While funding is important, it is really the partnerships that have been built with citizens, governments, and health-care providers as well as the increasing reliance on and use of science, technology and the body of medical evidence that can accelerate progress in this area. For instance, beyond the wide distribution of mosquito nets, ending malaria deaths will require making sure that effective diagnosis and timely treatment become available to every patient. Health authorities need to keep better track of where malaria still exists and which drugs produce the best health outcomes. We want funding to be targeted and effective, not a simple throwing of money at the problem.

In the wake of the global financial crisis, we face difficult choices with limited resources. Liberia, for one, has made it a priority to end deaths from malaria above many other pressing needs, for both health and economic reasons. As a result, Liberia is on track to protect its entire population by year’s end. But Liberia is not alone. Thirty-nine African countries have united against the disease under ALMA, chaired by Tanzanian President Jakaya Kikwete. This cooperation is the only way we can overcome the disease. No country is an island when it comes to malaria; mosquitoes do not respect borders.

In mobilizing the money, the bed nets and the treatment, and in strengthening supply chains for lifesaving medicines, our bedrock guiding principle must be stronger accountability. ALMA’s flagship accountability initiative is a simple tool, commonly employed in the private sector: a scorecard. (See TIME’s special report on the battle for global health.)

Currently under development with our partners in the Roll Back Malaria Partnership, the scorecard will track progress, identify what is working and what is not and highlight where intervention is required. We will further expand the use of new technology platforms, such as texting and Twitter, to reach hundreds of millions of people to create positive pressure at all levels, and to encourage demand for transparency, accountability and results by citizens.

Africa’s partners, including the World Bank, are committed to ending deaths from malaria. In 2010, the Bank pledged $200 million to anti-malaria efforts in Africa, largely to provide bed nets to families in the Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Mozambique, Sierra Leone and Zambia. This helped to close emergency gaps. Consistent with the priorities of African countries, we expect new financing, mobilized from the latest replenishment of the International Development Association, the Bank’s fund for the poorest countries, to be committed to the fight against malaria, including through our work on helping African countries build stronger health systems.

So as we take inspiration this week from African countries that now have malaria in retreat, we also need to recommit to finish the job. Allowing hard-won gains to be reversed cannot be an option.

Zoellick is president of the World Bank Group. Sirleaf is President of Liberia and the incoming chair of the African Leaders Malaria Alliance, whose members — African heads of state and government — are working to end malaria-related deaths in Africa.